About a month ago, my mother was crossing the street with her friend. Just as she stepped on the sidewalk she started feeling faint and began to feel sick. An ambulance was immediately contacted and my mother was taken to the ER. My mother’s friend accompanied her to the hospital — she called us from the hospital and told us to come right over.
My brother and I entered the hospital’s ER to find my Mom awake and alert. An ER nurse told us that my mother’s EKG was abnormal and that she had a condition known as Atrial Fibrillation and would need to take the medication, Coumadin.
A few hours later, my mother was admitted to the hospital. The physician on the unit determined the underlying medical issue, dehydration. We thought my mother was drinking enough fluids — obviously not. My mother was in the hospital for four days. Upon proper hydration, she was feeling fine and looking forward to returning home.
These are my observations regarding my mother’s recent hospitalization. I base the observations on my PIE Model of Patient Communication.
P Psychosocial (providing emotional support)
I Interviewing (getting information)
E Educating (giving information)
Everyone was very friendly and kind. I found the healthcare professionals to be very caring and treated my mother quite well. However, what I did not find was any direct empathic responses. I was waiting for someone to make a statement such as, “I know this must be difficult for you.” Every medical center and practice always mention that empathy is an important component of their work. In reality, empathy is rarely displayed. This is due to the fact that healthcare professionals are not educated on how to convey empathy.
The questioning techniques employed were sufficient to gather information from my mother and I. There was the usual issue of asking too many closed questions in succession and not allowing the patient sufficient time to discuss their medical issues.
The biggest issue was closing the interview with this question, “Do you have any questions?” That is a closed question. To encourage patients to ask questions, we should rephrase the question as an open question, “What questions do you have?”
Brace yourself and fasten your seat belt! This was by far the weakest area. Upon discharge, the unit nurse reviewed the discharge instructions, which were disjointed at best. There were so many issues, I almost did not know where to begin my evaluation. These are the problem areas and suggestions for improvement:
Excessive use of medical jargon: The discharge instructions used the terms presyncope and mixed hyperlipidemia. I am in the healthcare field and know what the terms mean, but what if I wasn’t in the field and didn’t know what the words meant? Use patient-friendly language.
Ultimate diagnosis not mentioned. My mother initially fainted, but was ultimately diagnosed with dehydration by the attending physician. Dehydration was never mentioned in the discharge report. This is a perfect of example of how poor handoffs lead to medical errors. At the time of discharge, I asked about the dehydration and how much fluid my mother should consume. The nurse said, “About 3-4 glasses a day, I guess.” (Having a solid healthcare background, I researched the topic and developed a daily fluid intake plan for my mother.)
Vague comments. The discharge form states, “Will order Influenza vaccine.” Was it ever administered to my mother? I called the hospital and was first sent to the Medical Records Department — they had no idea. The Medical Records Department sent me to the unit, who also had no idea. The unit nurse did say this, “Your Mom most likely did get the flu shot. We usually give it to people 50 or over.” Why didn’t the report state, “Patient was given a flu shot?”
No educational materials / resources. In spite of the fact my mother was diagnosed with dehydration, no information was provided. A brochure, website or organization to contact would have been helpful.
Overall, the healthcare professionals who took care of my mother were kind and skilled at their jobs. There were some issues with the interviewing questions and empathic responding, however the biggest concern was the poor patient education component. If patients do not comprehend their medical situation, they are at risk.
I signed the form for my mother (I have Power of Attorney). By signing the form, I indicated I understand the discharge papers. I actually did understand them — I have been in healthcare over 20 years. My biggest concern is that most people will sign the form stating they understand, but they really do not.
Hospitals need to do a better job at educating patients.
Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication. To book one of his high-content credit-hour-approved keynote speeches or training programs, visit or call: http://www.CommunicatingWithPatients.com / 1-800-677-3256